CAUDAL EPIDURALS - THE WHOOSH TEST

Caudal epidural injection is a simple procedure that carries a low ris k of complications. The whoosh test (injection of air into the caudal epidural space with simultaneous auscultation over the thoracolumbar s pine) has been recommended as an aid to correct needle placement. A 1- year prospective study, using fluoroscopic imaging to identify needle position, was conducted to compare the sensitivity and specificity of the whoosh test with that of clinical impression alone in assessing co rrect needle placement in the caudal space. Of 131 patients studied, c orrect needle placement tvas achieved in 121 an the first attempt (92% ). Clinical impression alone had a sensitivity of 94% and a specificit y of 20%. The whoosh test had a sensitivity of 80% and a specificity o f 60%. The whoosh test is superior to clinical judgment in detecting i ncorrect caudal needle placement.